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    Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry
    (Wiley, 2022-06)
    Ding, Wern Yew
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    Potpara, Tatjana S
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    Blomström-Lundqvist, Carina
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    Boriani, Giuseppe
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    Marin, Francisco
    Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF.
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    Arrhythmias in the Heart Transplant Patient
    (Radcliffe Group Ltd, 2014-11)
    Hamon, David
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    Vaseghi, Marmar
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    Shivkumar, Kalyanam
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    Boyle, Noel G
    Orthotopic heart transplantation (OHT) is currently the most effective long-term therapy for patients with end-stage cardiac disease, even as left ventricular devices show markedly improved outcomes. As surgical techniques and immunosuppressive regimens have been refined, short-term mortality caused by sepsis has decreased, while morbidity caused by repeated rejection episodes and vasculopathy has increased, and is often manifested by arrhythmias. These chronic transplant complications require early and aggressive multidisciplinary treatment. Understanding the relationship between arrhythmias and these complications in the acute and chronic stages following OHT is critical in improving patient prognosis, as arrhythmias may be the earliest or sole presentation. Finally, decentralised/ denervated hearts represent a unique opportunity to investigate the underlying mechanisms of arrhythmias.
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    First Macedonian Registry on Atrial Fibrillation
    (Hrvatsko kardiološko društvo, 2013-09-23)
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    Risteski, Dejan
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    Objectives: More than a half of the patients with atrial fibrillation (AF) are not adequately anti-coagulated, even though there is strong evidence in favor of the oral anticoagulant (OAC) therapy used in prevention of ischemic stroke in this patient-population. Most frequent factors causing this problem are: non-adherence to the Guidelines as well as the limitations like: difficulties in the maintenance of INR within therapeutic range, the necessity of monitoring and numerous interactions with food and other medications. Aim: Concerning non-adherence to the Guidelines all over the world in the treatment of the patients with AF, the aim of this Registry is to find the weak points in the treatment of these patients, and equilibrate the treatment all over the Country. Patients and Methods: More than 1,000 consecutive patients with AF in their electrocardiogram, diagnosed in the last year will be included in this Registry in the first year, from all over the country. All parameters concerning underlying cardiovascular disease will be listed and analyzed, also all co-morbidities. All diagnostic and interventional procedures, medications during this period will be analyzed, with special concern on anticoagulation therapy, type of anticoagulation, monitoring, and reason why, if not anti-coagulated. Analyses will be done in the way of treatment of the patient regarding the place of consultation: outpatient department, hospital, university clinic. Outcome points were defined as: cardiovascular death, death from other reason, ischaemic stroke, hemorrhagic stroke, transitory ischaemic attack, other major hemorrhage or thrombo-embolic complication. Results: Will be available at the end of the study; preliminary results will be due July 2013. Conclusion: General risk profile of patients with AF, frequency of anticoagulation, frequency of effective treatment and risks of bleeding will be evaluated. All outcome points will be analyzed, their independent predictors will be determined and the follow up will continue in the next 5 years.
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    Epidemiology and impact of frailty in patients with atrial fibrillation in Europe
    (Oxford University Press (OUP), 2022-08)
    Proietti, Marco
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    Romiti, Giulio Francesco
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    Vitolo, Marco
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    Harrison, Stephanie L
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    Lane, Deirdre A
    Background: Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. Methods A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. Results Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55–0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. Conclusions In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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    Strategies to Promote Long-Term Cardiac Implant Site Health
    (Cureus, Inc., 2021-01-03)
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    In the past several decades there has been a continuous growth in the field of cardiac implantable electronic devices (CIED) implantation procedures as well as their technological development. CIEDs utilize transvenous leads that are introduced into the heart via the axillary, subclavian, or cephalic veins, as well as a devices generator that is implanted in a subcutaneous pocket, typically in the pre-pectoral region. Despite this significant improvement, complication rates range from 1-6% with current implant tools and techniques. In this review we will discuss the three central parts of the CIED implantation procedure, their impact on implantation site, infections, and possibilities for its prevention.
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    LEFT VENTRICULAR LEAD PLACEMENT FOR PACING AND SENSING IN A PATIENT WITH ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY UNDERGOING ICD IMPLANTATION
    (Sestre Milosrdnice University Hospital Center (KBC Sestre milosrdnice), 2019-06)
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    Manola, Šime
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    Radeljić, Vjekoslav
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    Bulj, Nikola
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    Delić Brkljačić, Diana
    We present a case of a 64-year-old female patient scheduled for implantable cardioverter defibrillator (ICD) implantation due to arrhythmogenic right ventricular cardiomyopathy (ARVC). Dual coil, active fixation ICD lead was introduced through the axillary vein. More than 20 positions were changed in the right ventricle (RV) (outflow tract, high, mid and apical septum, infero-basal, apical and lateral wall). Maximum R wave amplitude was 2 mV with pacing threshold of 0.5 V. Since the sensing was inappropriate, we decided to place the pace/sense lead of the ICD in the coronary sinus. The lead was placed in the basal part of the lateral vein. The pacing threshold was 1.0 V/0.40 ms and R wave was 9 mV. The lead was connected to the ICD sense-pace port and high voltage coils were connected in the usual way. The RV sense-pace lead was capped off. The device sensed an R wave of 7.0 mV 48 hours later. The purpose of this report is to show a possible solution of sensing problems during an ICD implantation in a patient with ARVC.
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    Outcomes of digoxin vs. beta blocker in atrial fibrillation: report from ESC–EHRA EORP AF Long-Term General Registry
    (Oxford University Press (OUP), 2021-10-19)
    Ding, Wern Yew
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    Boriani, Giuseppe
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    Marin, Francisco
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    Blomström-Lundqvist, Carina
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    Potpara, Tatjana S
    Aims The safety of digoxin therapy in atrial fibrillation (AF) remains ill-defined. We aimed to evaluate the effects of digoxin over beta-blocker therapy in AF. Methods and results Patients with AF who were treated with either digoxin or a beta blocker from the ESC–EHRA EORP AF (European Society of Cardiology–European Heart Rhythm Association EURObservational Research Programme Atrial Fibrillation) General Long-Term Registry were included. Outcomes of interest were all-cause mortality, cardiovascular (CV) mortality, non-CV mortality, quality of life, and number of patients with unplanned hospitalizations. Of 6377 patients, 549 (8.6%) were treated with digoxin. Over 24 months, there were 550 (8.6%) all-cause mortality events and 1304 (23.6%) patients with unplanned emergency hospitalizations. Compared to beta blocker, digoxin therapy was associated with increased all-cause mortality [hazard ratio (HR) 1.90 (95% confidence interval, CI, 1.48–2.44)], CV mortality [HR 2.18 (95% CI 1.47–3.21)], and non-CV mortality [HR 1.68 (95% CI 1.02–2.75)] with reduced quality of life [health utility score 0.555 (±0.406) vs. 0.705 (±0.346), P < 0.001] but no differences in emergency hospitalizations [HR 1.00 (95% CI 0.56–1.80)] or AF-related hospitalizations [HR 0.95 (95% CI 0.60–1.52)]. On multivariable analysis, there were no differences in any of the outcomes between both groups, after accounting for potential confounders. Similar results were obtained in the subgroups of patients with permanent AF and coexisting heart failure. There were no differences in outcomes between AF patients receiving digoxin with and without chronic kidney disease. Conclusion Poor outcomes related to the use of digoxin over beta-blocker therapy in terms of excess mortality and reduced quality of life are associated with the presence of other risk factors rather than digoxin per se. The choice of digoxin or beta-blocker therapy had no influence on the incidence of unplanned hospitalizations.
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    Effects of CRT on atrial and ventricular arrhythmias in patients with HF
    (Oxford University Press (OUP), 2023-05-24)
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    Pocesta, B
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    Janusevski, F
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    Risteski, D
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    <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Funding Acknowledgements</jats:title> <jats:p>Type of funding sources: None.</jats:p> </jats:sec> <jats:sec> <jats:title>Introduction</jats:title> <jats:p>Cardiac resynchronization therapy (CRT) is an accepted treatment for patients with heart failure (HF). Cardiac arrhythmias present a significant and complex issue in this patient group. Evidence exploring the influence of CRT on cardiac arrhythmias rate variations is limited.</jats:p> </jats:sec> <jats:sec> <jats:title>Purpose</jats:title> <jats:p>Our research investigates the effectiveness of CRT in the treatment of existing and newly diagnosed atrial and ventricular arrhythmias, and impact of epicardial lead position on these arrhythmias rate variations, as well as on the CRT response.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This single-center, prospective, observational study included 75 consecutive patients admitted for CRT implantation over a 12-month period. All included patients had episodes of atrial and/or ventricular arrhythmias, diagnosed by 12-lead ECG or 24-hour Holter monitoring. Pre-procedural demographic characteristics were collected for all patients, including ECG records, NYHA functional class, echocardiographic assessment of left ventricular ejection function and questionnaire for quality-of-life. During device follow up atrial and ventricular arrhythmias appearance was monitored. Additional assessment of echocardiographic parameters, NYHA - functional class, quality of life and rate of major cardiovascular complications and rehospitalizations was performed.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The mean age of the patients was 62.4 ± 10.3 years, with 74.6% male and 25.3% females. 72% had a non-ischemic HF etiology. Pre-procedural paroxysmal AF was present in 34.7%, persistent AF in 36%, PVCs in 32%, NSVT 16%, and VT in 18,7% patients. 55% of the included patients were responders to CRT. Our results showed decrease in rate of all ventricular arrhythmias, with significant reduction in the percentage of VT (p=0.003), regardless of CRT response. Significant reduction of PVCs and NSVT rate (p=0.012 & p=0.024) was found in the responder group of patients. Regarding AF, our results showed a decrease in the number of AF events in both patient groups, however this was most visible in the responder patients with paroxysmal AF (p=0.057). In CRT responders, left ventricular pacing lead was most commonly located in a lateral branch vein of the CS with middle and mid/lateral position. In terms of quality of life and general condition of the patients, we noticed a significant improvement in the NYHA - functional class (p &lt;0.001), as well as in both parts of the quality-of-life assessment questionnaire (p=0.0135, p&lt;0.001).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>CRT is an effective treatment for atrial and ventricular arrhythmias in HF patients, especially in responders to this therapy. LV epicardial lead position proved to be very important influence in the process of LV reverse remodeling, which is in direct correlation of the CRT responders and its effectiveness in reducing the rate of cardiac arrhythmias.</jats:p> </jats:sec>